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Podiatrist - Washington
853 Jefferson Ave
Washington, PA 15301
(724) 225-7410
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By contactus
February 16, 2012
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Toenail Has The Blues     

Have you ever taken your shoes and socks off and noticed your big toe’s nail has turned a dark color? If so, do your shoes feel a little snug, both from front to back and from top to bottom in the toe area? You could be experiencing what is called a “subungual hematoma,” which is exactly what it sounds like: blood pooling underneath the nail plate. Often soon after injury, the nail will be red or bluish red. After a couple days, once the blood has clotted and dried, the color will be darker blueish brown.

This type of injury is caused from one of two types of injuries: indirect injury or direct injury. Indirect trauma is as described above, when you are active on your feet while wearing too tight of shoes, either in length or in the height of the toe box, or end section of the shoe where your toes are. With each step in tight shoes, or often even high heels for you ladies, your toenails are driven against the shoe material with enough force. This microtrauma, or repetitive low levels of force, builds up with time and eventually can cause the nail plate to begin to separate from the nail bed on the toe, which leads to the subungual bleeding. This type of injury is treated based on what percentage of the nail is showing blood underneath. Typically, if <50% of the nail is involved, I may try to remove the blood but keep the nail. If > 50% is involved, I will discuss the need to remove the nail, as it is likely to continue to separate from the nail bed and lift itself off eventually.

The other type of injury is direct trauma. This is when you drop something on your toe or run your toe into a hard object, such as a bedpost or doorframe. This macrotrauma, or greater amount of force at once, can again cause the nail plate to separate from the nail bed and cause bleeding. With this type of injury, we will take xrays of your feet to make sure there is no fractured bones, and I will discuss the possibility of removing the nail to make sure there are no open cuts or bone sticking through the skin underneath the nail.

Many of you may have an occupation that requires wearing stiff work boots, which is good for the obvious reason of protecting your feet from the above mentioned macrotrauma. However, it is very important that you have the correct size of workboot in order to prevent the microtrauma, or repetitive jamming of your toes into the end of your shoe. Please come see me if for no other reason than to make sure your workboots or shoes are right for you.

If there is any question, or you feel you have discolored nails and do not remember any trauma, please come see me. There are other, less common things that could be causing the nail discoloration, but it is important to find out the cause. Please remember two important things: 1) It is important to investigate your feet and legs every day to look for changes or abnormalities, and 2) it is just as important to not try any form of treatment on yourself at home without the direction of myself or one of our podiatry staff members. This second point is particularly important in regards to subungual hematomas, as many people try to drain the blood themselves at home. Call us today for an appointment, and we’ll be glad to take care of you.

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